Last week, an analysis by the American Enterprise Institute, a conservative think tank, showed the administration anticipates half to two-thirds of small businesses would have policies canceled or be compelled to send workers onto the ObamaCare exchanges. They predicted up to 100 million small and large business policies could be canceled next year.

According to projections the administration itself issued back in July 2010, it was clear officials knew the impact of ObamaCare three years ago.

In fact, according to the Federal Register, its mid-range estimate was that by the end of 2014, 76 percent of small group plans would be cancelled, along with 55 percent of large employer plans.

The reason behind the losses is that current plans don't meet the requirements of ObamaCare, which dictate that each plan must cover a list of essential benefits, whether people want them or not.

"Things like maternity care or acupuncture or extensive drug coverage," said Veuger. "And so now the law is going to force them to buy policies that they could have gotten in the past if they wanted to but they chose not to."

Some plans already have been canceled and employers are getting sticker shock at the new, higher prices under ObamaCare.

One of them is David Allen, president of a company bearing his name in Boulder, Colorado. He told a Congressional hearing recently that his carrier discontinued his company policy because it wasn't compliant with ObamaCare.

"It does not meet the minimum standards as stipulated under the law. Due to this one change," he said, "our premiums are now scheduled to increase by 52.3 percent in January 2014."

Enrollment in the Affordable Care Act through Colorado's health insurance exchange is barely half the state's worst-case projection, prompting demands from exchange board members for better stewardship of public money.

The shortfall could compromise the exchange's "ability to deliver on promises made to Colorado citizens" and threatens the funding stream for the exchange itself, according to board e-mails obtained by The Denver Post in an open records request.

The (stated) purpose was to get more people insured. Young people were not buying health insurance because it was too expensive, a lousy value for them. The answer was to pass a law prohibiting low cost policies and weigh the rest down with all kinds of coverage people don't want or need and make them pay for other people's care. Maternity coverage for celibate men and women with hysterectomies. No customization. We will get more people insured by canceling the majority of all existing policies. The cost per family will go up by $3400 instead of down by $2500, a $6000 per family per year 'rounding error'. Instead of making it affordable we will call it "Affordable". It is the most important item on the entire agenda, so we will have it start right after the next election.

We didn't get the cost down. We didn't get more people covered. But we did get government to take control of our lives. Mission Accomplished!

Fox's BB SR reports that the State of NH issued more moose hunting permits than people signed up for Obamacare.

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Supreme Court Agrees to Hear Contraception Cases, in Challenge to Health Law The Supreme Court on Tuesday agreed to hear a pair of cases on whether corporations may refuse to provide insurance coverage for contraception to their workers based on the religious beliefs of the corporations’ owners.The cases present a new challenge to President Obama’s health care law. The Supreme Court in 2012 upheld another part of the law, one that requires most Americans to obtain health insurance or pay a penalty.The Obama administration has exempted many religious groups from the law’s requirements for contraception coverage. But it said for-profit corporations could not rely on religious objections to opt out of compliance with the law. The lower courts are divided over whether such corporations may object to generally applicable laws on religious liberty grounds.READ MORE »http://www.nytimes.com/2013/11/27/us/justices-take-companies-cases-challenging-contraception-rule.html?emc=edit_na_20131126

RIGGING THE FUTURE: Obamacare Creates 50 New State Databases With No Function Beyond Gathering Potential Voter Information, Real or Fraudulent

It was never just a health care “fix”: A series of precise, brilliant, secretive, and illegal decisions by Obamacare authors led to the creation of 50 unbeatable election tools — and to nothing else. As you read, try to identify a rational explanation besides malevolence. (This is Part One of a two-part article.)by David SteinbergNov 26, 2013 - 8:25 am

Since the passage of Obamacare, all fifty state Medicaid agencies have been forced to create a new standalone database that contains nothing besides the contact information of Medicaid applicants who used Healthcare.gov.

Some of these new databases mail out voter registration forms automatically. You cannot refuse them.

No worthwhile verification occurs before the forms are mailed. Apply for Medicaid and the form will be mailed to you, be you a verifiable citizen or Ayman al-Zawahiri on a computer in Pakistan.

Further, these new databases are accessible by groups like Organizing for Action, the reconstituted ACORN, and malevolent figures like Chris Tarango.

And no reasonable purpose exists for creating the databases besides making them available to the aforementioned Democratic activists.

———————

Heard nothing regarding this before? Not only are you not alone, several state secretaries of State we contacted had no clue any of this was occurring under their watch. One source involved in the recently initiated legal battle to expose and dismantle the databases described the situation as follows:

Evil genius.

A complete disregard for certain federal law, the skirting of others, the exploitation of existing Medicaid structures, the issuing of rules and regulations with virtually none of the required paper trail. …

Just evil genius. They friggin’ thought of everything.

The remainder of this article is composed of descriptions of the several decisions made by Obamacare authors that led to the construction of the databases. The listing of these decisions is intended to illustrate the impossibility that these databases were created unintentionally, or due to incompetence — a “fumble.”

We hope to show that a rational, disinterested observer must arrive at the conclusion that these actions could not have been taken for any reason beyond the intended exploitation of the Affordable Care Act as a vehicle for future Democratic election victories.

We invite readers to offer alternative interpretations. We have reached out to several Democratic congressional offices to give them the opportunity to offer their own.

We also have reached out to GOP officials to see if any are willing to go on record stating the lone reasonable conclusion: objectively, some authors of the ACA were not “bleeding hearts,” but white-collar criminals.

Decision #1: The “Honor System”

Applicants to Healthcare.gov must enter their current income level. This is a pivotal piece of data for the system: income alone is used to determine if the applicant will be presented with the option to: a) purchase full-price or subsidized health insurance policies; or b) if the applicant will be directed towards Medicaid/CHIP programs. This determination is calculated according to the new Modified/Adjusted Gross Income (MAGI) scale.

However, Healthcare.gov does not perform any checks at all (such as requiring the submission of pay stubs, the prior year’s tax return, etc.) to verify the income amount entered by the applicant. This all-important piece of data is accepted by Healthcare.gov on the “honor system.”

Decision #2: The Community Organizing, Aggressive Application of “Motor Voter” Law

If an applicant’s entered income is low enough to be eligible for subsidy, the applicant will soon be asked by Healthcare.gov if he or she does not wish to receive a voter registration form. This question alone utilizes aggressive application of three provisions of federal law.

The 1993 National Voter Registration Act, or “Motor Voter,” requires all municipal and government facilities which provide public assistance to also offer voter registration services. The Obama administration claims that “Motor Voter” thus applies to Healthcare.gov, and subsequently Healthcare.gov must provide voter registration services. Some states have disagreed with this application as it relates to state exchanges, but expect those states to face DOJ litigation – Rhode Island and other states have.

1. Since the adoption of Motor Voter in 1993, the Federal Government has successfully forced states to push voter registration in all on-line contexts.

This represents a significant distinction: the federal government has necessarily crafted entirely new fields of law to handle the development of electronic interactions.

2. Motor Voter specifies that facilities offering public assistance must have voter registration services available, and the Federal Government is forcing applications to specifically reject voter registration, sometimes multiple times.

As such, you can draw your own conclusions about the motivation behind applying Motor Voter to the ACA, and behind phrasing the question in that manner.

3. A stunning apparent violation of federal law: In practice, Healthcare.gov does not let you say “no” to a voter registration form.

Even if you say “no,” you may be mailed a form automatically.

You may receive a form that is pre-populated with the identifying information you entered into Healthcare.gov. Comprehension of the form is thus unnecessary; the recipient of the pre-populated form need only determine where to sign it.

As explained below, this will occur at the state level, where the design and implementation of Obamacare regarding voter registration make these transparently intentional abuses of Motor Voter seem tame.

Among sources reached for this article, that phrase “evil genius” was employed when referring to what Obamacare requires of state Medicaid entities; we were told its usage has become commonplace.

Since the enactment of LBJ’s Great Society public assistance programs, most state Medicaid agencies have not been responsible for handling eligibility screenings.

Generally, screening for the various public assistance programs has instead been handled by state departments of Health and Human Services, or by similar state entities. One system would screen for all of the public assistance programs; the individual state program agencies would only handle administration.

After 50 years of precedence, Obamacare has changed this. But only for Medicaid.

As discussed earlier, if an applicant enters a qualifyingly low income into Healthcare.gov, the applicant is sent to the Medicaid side of the website. At this point, those five decades of established fraud prevention procedures are jettisoned.

Identifying information entered on the Medicaid side of Healthcare.gov is treated differently than identifying information entered while applying to all other public assistance programs.

How it works now: each state Medicaid agency has been instructed to create a new stand-alone database for storing identifying information entered by Medicaid applicants via Healthcare.gov. (Note the word “instructed,” not “required by law” or something similar. We will get to that shortly.) As instructed, all fifty states have created one of these databases.

They have further been instructed that this identifying information should no longer be sent to whichever state organization formerly performed the eligibility screening. The information must only go to these new databases.

Decision #4: The Parting of Data

As instructed, each state designed these new stand-alone databases to be dedicated to storing only the identifying information of Healthcare.gov applicants — but no medical data.

If you happen to be familiar with the basics of both health care and election law, perhaps your pupils just grew wide. Because you are aware that medical records are treated by the law as private and sacrosanct, but voter rolls, consisting of only identifying information, are publicly accessible.

To summarize: •The federal government instructed states that they could not send any applicant data entered into the Medicaid side of Healthcare.gov to their traditional eligibility screeners. •They then instructed state Medicaid agencies to create stand-alone databases for this new applicant information, and that these new databases would be forbidden from containing any medical information. •Per an incorrect application of Motor Voter law, the Obama administration considers the Medicaid side of Healthcare.gov to be a public assistance “office,” and as such, required to offer voter registration services. •The Obama administration also considers it legal to treat the distribution of voter registration forms as “must opt-out,” instead of “must opt-in.”

States were instructed that, to comply with Motor Voter, these new databases must automatically mail voter registration forms to each new individual applicant sent over from Healthcare.gov.

Recall, you may have said “no” earlier. It doesn’t matter.

The new databases must also mail a second form that states “I do not wish to register to vote,” which you must sign and return.

Otherwise, it is assumed you wish to register.

If the Feds notice you still haven’t replied?

Remember Decision #4: the new databases are publicly accessible, since they do not contain any medical information.

Anyone – perhaps Organizing for Action, or Battleground Texas – can get their hands on it, and then show up at your door with yet another form.

——————–

Review the prior five decisions: are you able to determine a reasonable explanation for all five of them besides getting potential voter information in the hands of Democratic organizing groups? Groups populated by bad actors like Chris Tarango, but which nonetheless have the blessings of the administration?

Recall that this is voter information gathered via Medicaid applications, a program whose recipients vote almost exclusively Democrat.

If Orwell comparisons strike you as tedious, an additional instruction to the states about how they are allowed to screen eligibility, along with the precedent-breaking, whispered demands from the Centers for Medicare and Medicaid Services (CMS) that follow may have you granting an exception.

Decision #6: Eliminating the State Medicaid Screeners

For the past five decades, states have dedicated a tremendous amount of resources to providing a “second-level review” of applicant information transmitted to them via a federal agency.

But now, and quite simply, that has been ended. But only for Medicaid.

States are no longer allowed to challenge the validity of applicant information sent to them from the Medicaid side of Healthcare.gov.

Instead, states are to assume that if information was transmitted to them, the federal government has deemed that information to be valid. States haven’t simply been instructed to no longer let their traditional public assistance eligibility screeners touch Medicaid information from Healthcare.gov — they have been instructed that state Medicaid agencies can’t screen it, either. This isn’t an administrative shift of the state screening processes, it’s the forbidding of state screening processes.

We already know what little concern Healthcare.gov itself has for the validity of applicant information. The site employs the “honor system” for income, the most important piece of data. Also, as previously reported at PJ Media, the Medicaid side of Healthcare.gov allows anyone on Earth to secure at least 90 days of Medicaid with just two easily forged documents and a lie about being a legal alien.

The security bar is even lower for entrance into one of the new state “Medicaid/voter roll” databases. In fact, it’s non-existent: apply for Medicaid as a citizen, you’re going to end up in your state’s new “Medicaid/voter roll” database.

And the state is forbidden from checking the application’s validity.

————————-

This development represents an endpoint, with identifiable products of those six federal decisions. The products are: •Fifty unscreened databases, accessible to all, of identifying information of likely Democratic voters. •Fifty databases of likely Democratic voters, which automatically mail voter registration forms and required “opt-out” forms to each applicant.

What is the rational result of these two final products following their implementation? •The Democratic Party exploiting a federal law passed without a single Republican vote, a law that mandates citizen participation, a law that mandates citizens purchase a product to sustain the law financially, to produce an unbeatable tool to utilize for winning elections. •Bad actors within the Democratic Party, both within and outside of government, using this tool to easily commit voter fraud. •An organized entity hostile to the United States exploiting the massive security holes created by this Democratic law to flood the Medicaid rolls with fraudulent enrollees, rendering the massive program database unusable. •An organized entity hostile to the United States exploiting the massive security holes created by this Democratic law to flood the voter rolls with fraudulent identities, rendering the administration of elections impossible.

To employ an example from our prior article on fraudulent 90-day Medicaid enrollments: 1.Al-Qaeda leader Ayman al-Zawahiri, from a computer in Pakistan, can tell Healthcare.gov that his income this year is zero. 2.He will be directed to the Medicaid side of the website, where he can claim to be an American citizen temporarily living abroad. 3.He can enter the address of his local post office. 4.Al-Zawahiri will have himself a voter registration card arrive shortly. 5.He can instruct his millions of supporters to do the same.

If Healthcare.gov was actually working, al-Qaeda could get that done by the weekend.

——————

How did the Obama administration accomplish this? Where’s the paper trail? Aren’t there established processes for the development and implementation of rules and regulations applying to a federal bill, and aren’t all of those deliberations required to be publicly released?

Yes. But in perhaps the Obama administration’s worst “fumble,” they bypassed just about the entire rule-issuance process.

Decision #7: Breaking All the Rules

In Part Two of this article, to be published following the Thanksgiving holiday, we will discuss how the federal government’s Centers for Medicare & Medicaid Services, or CMS, acted in a precedence-shattering, secretive manner in issuing orders to state Medicaid agencies regarding how to construct the databases.

We will also discuss the massive security holes created by the allowance of “telephonic signature,” and the secretaries of State who were left completely in the dark.

We will link, post, and discuss the paper trail — and who was involved.

And we will discuss the George Soros-funded Demos organization, which helped push the “opt-out” approach to Motor Voter, and which happened to be one of the few entities that had any knowledge of the new databases.

Indeed, they happened to have enough knowledge regarding the databases to prepare and publish a report containing state-by-state strategies for taking advantage of them.

Obama Redistributes Health, Not Just WealthBy DICK MORRISPublished on DickMorris.com on November 26, 2013Printer-Friendly VersionThe New York Times, on November 23rd, reports that redistribution has become the unmentionable word at the Obama White House. Former Chief of Staff William Daley says that redistribution is "a loaded word that c0njures up all sorts of unfairness in people's minds." He notes that it is a word that in the political world, you "just don't use."

But the newspaper goes on to note that "the redistribution of wealth has always been a central feature of the ObamaCare law and lies at the heart of the insurance market disruptions driving political attacks this fall."

The New York Times, as usual, misses the point. It is not the redistribution of wealth that is the main problem. It is the redistribution of health that bothers us most of all. Money is one thing. Our health and lives are quite another.

By restricting access to certain doctors, hospitals, and therapies, ObamaCare limits our access to health. There are forty drugs that address specific types of cancer genetically. The average ObamaCare policy covers ten of them. If you have one of the others, you are out of luck.

By cutting reimbursement rates to doctors and encouraging their early retirement, ObamaCare dumbs down health care so everybody gets a little, but nobody gets a lot and many don't get enough. Even with issues of life and death at stake, ObamaCare limits our options.

We cannot go to Sloan Kettering or the Mayo Clinic or Ceders-Sinai if we have cancer. Its not covered. Nor can we count on ever seeing an oncologist. Very few will accept the low reimbursement rates offered by the system.

A heart patient will rarely get to see a cardiovascular specialist nor will someone suffering from colon disease get to see a gastroenterologist. The reimbursement rates are prohibitively low for these specialists. And, if you go out of network, you have to pay the full freight yourself, including any follow on therapies. Not just a penalty, but the full amount you'd have to pay if you had no coverage.

A top New Jersey Orthopedist called into my radio show and said that there was no one in south Jersey in any of the ObamaCare plans who was capable of performing complex spinal surgery.

ObamaCare redistributes wealth by charging those whose policies have been cancelled a premium to cover the uninsured. And, it charges a 40% premium tax on those with good policies. And it charges a fee of $63 a head for group plans. All this money goes for the poor and uninsured.

But it is not the redistribution of wealth that is the key point. It is the redistribution of health that none of us can afford.

The Next ObamaCare MirageThe new line is that the health-care law will save money. That's also not true.By Thomas Miller and Abby McCloskeyNov. 25, 2013 6:58 p.m. ETWSJ

Supporters of President Obama are working overtime to backtrack from his promise that "If you like your health-care insurance, you can keep it. Period." While the president has conceded that this statement was inaccurate, the administration doesn't seem to have learned its lesson. The damage control plan is to spread another falsehood about the Affordable Care Act.

The claim this time is that the health-care "cost curve is bending, and the ACA is a significant part of the reason." That was what David Cutler —an influential Harvard economist and senior health-care adviser in Mr. Obama's 2008 presidential campaign—wrote in a Washington Post WPO +0.40% op-ed on Nov. 10.

The president jumped on this theme in his press conference on Nov. 14. "I'm not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years," he said. On Wednesday, the White House Council of Economic Advisers published a report claiming that "the ACA is contributing to the recent slow growth in health care prices and spending."

These assertions border on nonsense.

National spending on health care is projected to reach a record $2.9 trillion in 2013, according to the Centers for Medicare and Medicaid Services. This is more than 25% above pre-recession spending levels in 2007. Health-care expenditures per capita and as a percentage of GDP are also at record highs, expected to top out this year at $9,216 and 18% respectively.

The only apparent bright spot is that the average annual rate of health-care spending increases has slowed. Over the past three years, growth in health-care spending averaged 3.9% year-over-year, considerably slower than the historical average.

However, annual health-spending growth rates began to decline a decade ago. In 2002, health-care spending grew by nearly 10% in a single year. The growth rate dropped to 7.1% in 2004, 6.2% in 2007, and bottomed out at 3.9% in 2009—the worst year of the Great Recession, where it has stayed ever since. ObamaCare was enacted in 2010.

CMS and the Congressional Budget Office attribute the general slowdown in health-care spending increases over the past decade to a variety of factors, including increased cost sharing in private health plans and a slower rate of introduction of new health technology. An Urban Institute analysis points to how the mix of health-care payers has shifted over the past decade toward lower-paying government programs providing a greater share of coverage (particularly Medicaid).

Still, the recession is recognized by objective analysts as the single largest driver of slowed health-care spending in recent years. Many who lost their jobs lost their health insurance. Tight on cash, they opted out of surgery, hospital visits and prescriptions.

Changes in health-spending growth rates traditionally lag about two years behind changes in national economic growth. In September 2013, CMS reported that the depth and severity of the recession was more substantial than expected and revised its spending estimates downward accordingly.

In other words, champions of ObamaCare have little to crow about, once one recognizes that the persistently weak economic recovery has overlapped with the law.

And in the future? According to health-care actuaries at the Centers for Medicare and Medicaid Services, health-care spending will begin spiraling upward again starting next year, as the Affordable Care Act takes full effect. It will reach $5 trillion in 2022, or 20% of GDP, or $14,664 per capita. By 2022, ObamaCare alone is projected to increase cumulative health spending by roughly $621 billion, according to CMS.

In his 2008 campaign, Mr. Obama promised that his health-care reform plan would save a typical family $2,500 in annual premiums by the end of his first term. This was Mr. Cutler's prediction, and it was based on projected rapid returns from larger federal investments in health-information technology, new reinsurance subsidies for high-cost workers, and savings on administrative costs for health insurance.

Those cost savings haven't materialized. Mr. Cutler maintains they will, mostly through other untested reforms, and the White House Council of Economic Advisers report points to potential savings from fledgling Accountable Care Organizations, lower Medicare reimbursements, value-based payments and hospital readmission penalties. To be sure, some of these programs have and may result in small savings, but they had little effect on savings claimed from 2010 to 2013. For example, even the president's Council of Economic Advisers hedges that some of the claimed savings from reduced hospital readmission rates "may not be entirely attributable to the ACA payment incentives."

CMS actuaries find that any positive effects of the ObamaCare delivery system experiments on the cost of health care "remain highly speculative." When they compare their September 2013 projections with earlier estimates in April 2010, these actuaries find that the law would increase national health spending higher than previously expected by an additional $27 billion in 2019 alone.

To argue that the Affordable Care Act has been and will be a key driver of slower health-care spending is irreconcilable with the most basic facts about such spending over the last decade, as well as with the judgment of the executive branch's own team of actuaries responsible for health-care accounting and future projections.

Mr. Miller is a resident fellow at the American Enterprise Institute and former senior health economist on the Joint Economic Committee. Ms. McCloskey is program director of economic policy at the American Enterprise Institute.

Obama-ites are asking Dem Senators to find examples of people having a positive experience with Obamacare and bring forward their stories. The President himself brought forward the story of Jessica Sanford. Oops.

President Obama used Jessica Sanford as an Obamacare success story during his October 21 health care event. However, only three days later, Sanford turned into another Obamacare failure.

CNN reports that Sanford, a 48-year-old single mother from Washington state, purchased health insurance from the Washington state exchange. She was so excited that she emailed the President expressing her gratitude. He read the email during a health care event at the White House Rose Garden.

Three days later, Sanford said that she started receiving letters from her state’s exchange explaining that its tax credit calculator was incorrect, and instead of receiving a federal tax credit, she was not eligible. That meant the cost of her insurance would be higher than she anticipated—so high that she said she could not afford it.

“It was like riding a big rollercoaster,” she said. “They have my credit card, they have the payment date and then, you know, once again I’m knocked down, and this time it’s to zero. And at my rate of pay, with my family size, I just don’t understand why I wouldn’t get at least a little help with a tax credit.”

“It was a huge disappointment,” Sanford said. “Especially since I had, you know, my story had been shared by the President.”

As millions of Americans see their health-insurance premiums increase, have their coverage dropped as a result of the Affordable Care Act, and are unable to use the federal exchange, Oklahoma has sued the Obama administration. The Sooner State and several others are trying to stop the government from imposing tax penalties on certain states, businesses and individuals in defiance of the law. If these legal challenges are successful, the deficit spending associated with the new health-care law could be reduced by approximately $700 billion over the next decade.

While the president's health law is vast and extraordinarily complex, it is in one respect very simple. Subsidies are only to be made available, and tax penalties for not signing up for health insurance are only to be assessed, in states that create their own health-care exchange. The IRS, however, is attempting to enforce tax penalties in all states—including Oklahoma and the majority of the other states that have declined to create their own exchanges. Citizens and businesses in these states must use the federal exchange instead.Enlarge Image

Bloomberg News

The distinction is critical, because under the terms of the law it is the availability of government insurance-premium subsidies that triggers the penalties against businesses if they fail to provide their employees with health insurance that the administration deems acceptable. This is a huge problem for the administration, which desperately needs to hand out tax credits and subsidies to the citizenry to quash the swelling backlash against the law.

When Oklahoma first raised this challenge in 2012, many experts predicted that the Sooner State would "go it alone" in pursuing this legal strategy. Not so. In Indiana, the state and 15 school districts have filed a lawsuit against the IRS, the agency that collects the penalties. Business owners (who, like the state of Oklahoma, would be subject to penalties as employers) and individuals in Virginia and the District of Columbia have done the same. In the D.C. lawsuit, the presiding judge recently rejected the Obama administration's attempt to have the case dismissed, as the judge in the Oklahoma case did in August.

Motions for summary judgment will soon be filed in federal district courts, and our court system will determine whether what the administration has called its "improvements" to the ACA—essentially by ignoring some of its provisions—are lawful.

They are not. Congress was exceedingly clear that tax credits and subsidies are available to people whose plans "were enrolled in through an exchange established by the State under section 1311 of the Patient Protection and Affordable Care Act." Even so, the administration argues that Congress intended for all Americans to receive subsidies regardless of whether they enrolled in health-care coverage through a state exchange or a federal exchange. But to arrive at that conclusion you have to ignore the plain language of the law. And nowhere in the law did Congress authorize the IRS to provide the credits or subsidies to those other than citizens who buy their insurance through an exchange established under section 1311 of the ACA—i.e., a state exchange.

Congress specified that credits and subsidies are only to be available in states that set up their own health-insurance exchange for a reason: It could not force states to set up exchanges. Instead, it had to entice them to do so. Oklahoma's lawsuit is about preserving the state's authority to make a policy decision granted to states under the Affordable Care Act. Our governor and policy makers in Oklahoma decided it wasn't in the state's best interest to create a health-care exchange. The IRS, at the administration's bidding, is attempting to take away the benefits of that choice by regulatory action. Such attempts to expand the power of the executive branch should be troubling to all Americans.

While much time has been devoted in Washington to the issue of "defunding" the Affordable Care Act, the success of these lawsuits would have much the same effect. Should the courts decide the IRS is exceeding its authority and isn't allowed to assess the employer penalties in states that have not established their own exchanges, the structure of the ACA will crumble—as one of the primary mechanisms the federal government has employed to force people into the health-insurance market evaporates.

As much as we wish the government were run like a business, the administration cannot "improve" upon legislation passed by Congress by rolling out updates in the manner that Silicon Valley does. That's not permitted under the Constitution: Congress passes laws, the president executes them. Period. That's why Oklahoma and other states are fighting to stop the administration's attempt to "fix" the health-care law through executive fiat.

This is to me an unspeakable and unforgiveable outrage. With all the threats and regulations we as providers of health care face with the Health Insurance Portability and Privacy Act (HIPPA) we now see this:

Answer to the following question is yes. Half or more of the country will always hate it. The group that will benefit will love it. And eventually it will be patched up and we know for sure the Crats will go crazy on the airwaves brainwashing us as to how great it is. So yes the Pubs need to be ready. Will they? History tells us no.

IMO Levin is correct about this too. Waiting for AHA to collapse on itself is a major mistake. The Crats won't let it. It has to be appealed.

****Do Republicans need a Plan B on ObamaCare?

By Jon Terbush 7 hours ago The Week

John Boehner may need another playbook.For years, Republicans have trotted out the same message: ObamaCare is a massive disaster, and the public knows it. And when Healthcare.gov crashed out of the starting gate, that message proved quite resonant.

Yet as ObamaCare begins to turn the corner, Democrats are going back on the offensive, touting the law's benefits and successes in hopes of boosting support for it — and the party — ahead of the 2014 elections. Republicans, meanwhile, have so far stood by the same critiques, betting that the law will still be seen as a failure come Election Day.

Which raises a thorny question for the GOP: What if ObamaCare works?

Undoubtedly, ObamaCare is now functioning better than it was in October. Though problems remain for the exchange site — the back end is still a mess, often sending bogus or incomplete information to insurers — enrollments are reportedly surging through both the federal and state-run marketplaces.

Good news in hand, the White House and congressional Democrats this week launched a campaign of daily pro-ObamaCare messaging to promote the law ahead of the Dec. 23 enrollment deadline for coverage that kicks in Jan. 1, 2014. Their goal is to present a "raw two-sided picture," according to Politico, with "Democrats delivering benefits on one side, and Republicans trying to deny them on the other."

If ObamaCare keeps improving, the GOP's "we told you ObamaCare was a mess" pitch could quickly wear thin. And if it does, Republicans will find themselves in need of a new argument or a legislative alternative.

So far, they don't really have either.

On the messaging front, Speaker John Boehner (R-Ohio) on Tuesday repeated boilerplate GOP criticisms that the law was "fundamentally flawed," and that it "continues to wreak havoc on American families, small businesses, and our economy." Other GOP leaders similarly contended that the law was still a problem-plagued failure.

That the message hasn't changed despite ObamaCare's turnaround proves that "Republican complaints of two months ago were purely opportunistic," wrote Jamelle Bouie over at the Daily Beast.

"For them, it just doesn't matter if Healthcare.gov is working, since ObamaCare is destined to fail, reality be damned!" he added. "At most, the broken website was useful fodder for attacks on the administration. Now that it's made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster."

The GOP has also yet to offer a credible legislative alternative to ObamaCare. Though there are several Republican bills that would reform the health care system, they're generally considered suspect, and none have consensus support within the GOP. Boehner on Tuesday tellingly dodged a question about whether he would even bring up such a bill up for a vote, saying only, "We'll see."

Polls have shown that while voters aren't too keen on the health care law, they're willing to give it a chance. Indeed, the first few months of ObamaCare's disastrous rollout could be a distant memory once coverage and benefits kick in next year.

Which points to another problem for Republicans: Their anti-ObamaCare crusade will be tough to sustain once people begin to see the law's benefits in action. Mother Jones' Kevin Drum sussed out that point, writing, "Once the benefits of a new program start flowing, it's very, very hard to turn them off."

By the middle of 2014, ObamaCare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown…

Given all this, it's hard to see ObamaCare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. ObamaCare's taxes don't touch anyone with an income less than $200,000. Aside from the tea partiers who object on the usual abstract grounds that ObamaCare is a liberty-crushing Stalinesque takeover of the medical industry, it's going to be hard to gin up a huge amount of opposition. [Mother Jones]

Republicans have so far committed themselves to staunchly opposing ObamaCare no matter what, even producing a playbook for attacking the law from here to November 2014. But if ObamaCare continues to improve, the GOP might need to draw up a new play — or risk getting burned at the polls****

I share your frustration. Still it is important to lay the blame for Obamacare on those who support it, not those who oppose it.

Ben Carson had it right. If Obama is going to continue to sell it, Republicans especially in the Senate should be calling for a new authorization vote to see how that sale is going.

What is wrong with Obamacare was not a bogged down website, it is the whole concept from start to finish, mostly the fact that we are handing our individual liberties, choices and privacy over to the government never to get them back.

The problems before Obamacare were two-fold: Not enough people insured and healthcare costs were going up too fast. Too many young people who could afford it were uninsured because they thought it was a lousy value; they would be paying for other people's problems and for a lot of coverage they didn't think they needed.

Enter Obamacare. It makes all of that much worse in price and desirability but adds a government mandate, enforced by the IRS, that is just about to go into effect - or be delayed like everything else.

Not mentioned often anywhere are some of the underlying facts:

1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.2) The old already had coverage.3) This was mostly to 'help' who didn't want help.4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.

The result of Obamacare so far is that we are seeing one new enrollee for every 50 who are losing their plan!

Republicans disagree on tactics for ending the failed program, and the clock is ticking. As ccp suggest, a number of people and groups are going to come to rely on it making repeal harder later.

Democrats are now upside down in 13 states with contested Senate races in less than a year.

Obamacare needs to be repealed by the people left who passed it - Democrats. Where is their plan?

If we merely legalize free choice in a free country, the government plans can compete on a level playing field.

With Obamacare in place we get this, the central planners method of allocating scarce resources, replacing individual choice:

1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.2) The old already had coverage.3) This was mostly to 'help' who didn't want help.4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.

END

This is important and needs to be fleshed out.

1) Exactly how did the poor already have unlimited coverage?2) " " " " old " " " " ?3) I would restate this as "this was to tax those who didn't really need much insurance".4) Of course! But we need to have specifics e.g. the fragmentation of the national market into 50 markets, exactly what are the limitations on HSAs-- and the benefits, etc5) Yes, but we need citations of some sort.

Another one of my colleagues expressed his opinion that for doctors it is better to have a single payer. Yes they will control us and squeeze us endlessly. It is his opinion that is preferable to the myriad insurance companies each with their own multiple plans and rules. Certainly they fight us every tooth and nail. We spend fortunes just having to navigate the myriad systems. Not that a single payer Federal system would be a piece of cake but just that we would know exactly what we are dealing with and would eventually learn the system. I definitely don't agree with this. I don't want government controlling our lives. I just mention this to note some doctors do feel differently. We will see more and more of this kind of stuff as the politburo members slowly propagandize us towards a single payer system. The young and dumb will not even know what hit them. We all know there are big problems in health care and we know much of the following to be true. But again this sounds like the opening act to the next big propaganda push we on the right know is coming:

********Advocacy and policy news for internists

U.S. Health Care Falters When Compared With Other Countries, New Survey Finds

More Americans say they forego care because of access problems and a costly, confusing system

The U.S. health care system is a bewildering and expensive muddle that most people would like to see changed, even if they have insurance, according to a report in the November issue of Health Affairs.

It found that three of every four Americans surveyed said they would like to see a fundamental restructuring of health care in the country.

"There is a real call for moving away from the status quo," said study co-author Cathy Schoen, senior vice president for research, policy and evaluation at the Commonwealth Fund, which conducted the survey.

Problems with health care cropped up even among Americans covered by health insurance, the researchers found. As Schoen said, "We have a lot of people who, even when they have an insurance card, their insurance has holes in it."

The survey also included citizens of 10 other countries, and comparing the foreign responses to those of Americans revealed serious differences in the way health care works in the United States compared with elsewhere. For instance:

A third of all Americans, both insured and uninsured, reported going without medical care when sick because of the cost. About 58 percent of the uninsured skipped needed care. By comparison, fewer people reported a cost barrier to care in each of the other 10 countries surveyed. In eight of them, 14 percent or fewer people said they had to skip care because of money concerns.

About two of every five Americans had more than $1,000 in out-of-pocket medical expenses for the previous year, whether or not they had insurance. "Even when we're insured, the United States is an outlier," Schoen said. "The insured went without care because of cost and were on the high end of spending out-of-pocket." Among the other countries, Australia and Switzerland had about 25 percent of their citizens reporting more than $1,000 in out-of-pocket medical spending, but the rest had far fewer people who spent that much.

About 25 percent of Americans said they waited six days or more to see a doctor the last time they needed care. That increased to 40 percent among the uninsured. However, three-quarters of Americans were able to see a specialist in less than four weeks. Access to physicians proved better in most other countries. Only in Canada (33 percent) and Norway (28 percent) did more people have to wait six days or more to see a doctor. Access to specialists was much worse in other countries, though in Switzerland, the United Kingdom and The Netherlands, a comparable number of people were able to see a specialist within a month.

More people in the United States rely on emergency room care, with 36 percent of the insured and 48 percent of the uninsured saying they visited an ER within the last two years. By comparison, about 41 percent of Canadians said they had been to the ER recently, but people in the other nine countries reported less reliance on emergency care. For example, 28 percent of people in New Zealand, Norway and Switzerland had been to an ER in the past two years.

Americans also reported more bureaucratic battling over their health benefits. "A third of people spent a lot of time on paperwork or had insurance disputes where their insurance didn't cover as much as they expected it to," Schoen said. That was more than any other country. The next highest, Switzerland, had 25 percent reporting health benefit problems. Sweden and the United Kingdom had just 4 percent reporting that they had to dispute bills or deal with unexpected costs.

"These are all symptoms of a care system under stress," Schoen said. "We spend more than any other country, but we are more likely to forego care."

A leading health economist, Stuart Altman, said that none of the findings were all that surprising.

"It's all the reasons why we need to cover more people, try to make the system a little simpler, and see if we can get our costs down," said Altman, a professor of national health policy at Brandeis University.

"What's interesting is, even among our wealthier citizens, there is a fair amount of apprehension about the confusing system we live in," Altman said. "That was a very telling piece of their analysis. It's a complicated health care system we have. There's no going around it."

Schoen said she hopes that when the Commonwealth Fund does the survey again in a couple of years, the changes wrought by the Affordable Care Act will improve the cost and access problems that Americans reported in the current survey.

"The hope is we will have brought in the insurance for people who don't have any, and the insurance will be more meaningful," she said. "We're expecting this to look better in the future. It's really a benchmark."

Altman was not as optimistic, however.

"Many of the issues are not going to go away," he said. "The Affordable Care Act is an attempt to reduce the number of people who are uninsured over time, and that's a good thing, but it does not in and of itself make our system less confusing."

» Help Your Patients Enroll in ACA Exchanges People looking for coverage starting Jan. 1 have until Dec. 23 to enroll through the health insurance exchanges. ACP can help you provide your patients with information about how to enroll in your state’s new health insurance marketplace. Find answers to questions your patients may be asking about enrolling or health care reform in general. Also find state-specific contact information for the marketplace in your area. While the deadline is the 23rd to have coverage be effective in January, enrollment in the exchanges will continue through March for people who still need to sign up. » Become an Advocate for Internal Medicine Join ACP’s Advocates for Internal Medicine Network (AIMn). You’ll find updates about the latest legislation affecting internists and be able to help contribute to ACP’s continued success on Capitol Hill. In addition, the program will provide you with legislative alerts designed to help you easily email or call your members of Congress to let them hear about the issues important to you and other internal medicine physicians.

This is exactly why we need to be aggressively presenting our solutions!!!

One that I would put front and center is that prices must be knowable, just as we must be informed about what we buy (ingredients, weight, price). Indeed, with deductibles going so high, oddly enough we can argue that there are some forces for market pricing to come to bear.

1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.2) The old already had coverage.3) This was mostly to 'help' who didn't want help.4) The problems with the old system mostly had to do with government already screwing up the market. Healthcare wasn't a free market before Obamacare.5) At the time of its passage, Republicans had the popular part in their own alternative - a plan to cover people with pre-existing conditions.

END

This is important and needs to be fleshed out.

1) Exactly how did the poor already have unlimited coverage?2) " " " " old " " " " ?3) I would restate this as "this was to tax those who didn't really need much insurance".4) Of course! But we need to have specifics e.g. the fragmentation of the national market into 50 markets, exactly what are the limitations on HSAs-- and the benefits, etc5) Yes, but we need citations of some sort.

Getting back to you with some citations on the above...

1) The poor already had unlimited free healthcare in America. This never was about helping the poorest among us.http://en.wikipedia.org/wiki/MedicaidMedicaidIn 1966 welfare recipients of all ages received medical care through the Medicaid program. Medicaid was created on July 30, 1965 under Title XIX of the Social Security Act of 1965.Health care in the United States, Government Health Programs Federal Employees Health Benefits Program Indian Health Service Veterans Health Administration Military Health System / TRICARE Medicare Medicaid / State Health Insurance Assistance Program (SHIP) State Children's Health Insurance Program (CHIP) ('Children's healthcare isn't just for children anymore!) The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.One public hospital here alone spends half a billion a year on unreimbursed medical expenses, 3 million on translators, 100 million on 'foreign born' patients, etc. http://www.nytimes.com/2009/03/29/health/29immig.html(No one is alleging the poor didn't already receive free health care in America.)

2) The old already had coverage.http://en.wikipedia.org/wiki/Medicare_%28United_States%29MedicareThe Social Security Act of 1965 authorized Medicare and provided federal funding for many of the medical costs of older Americans.[19] The legislation overcame the bitter resistance, particularly from the American Medical Association, to the idea of publicly funded health care or "socialized medicine" by making its benefits available to everyone over sixty-five, regardless of need, and by linking payments to the existing private insurance system.[Obamacare was not aimed at the aging; they already have a program.]

3) This was mostly to 'help' those who didn't want help."this was to tax those who didn't really need much insurance"Nothing says personal accountability like a government mandate.Identify people who don't want to pay their fair share and make illegal to pay only their share.

http://cnsnews.com/news/article/republicans-have-offered-three-alternative-health-care-reform-billsRepublicans Have Offered Three Alternative Health Care Reform BillsAugust 21, 2009The “Patients Choice Act” has been referred to the Senate Finance Committee, which is set to release a Democratic-crafted bill from that committee when Congress returns after Labor Day. In June, DeMint, chairman of the Senate Steering Committee, introduced the “Health Care Freedom Plan,” which was analyzed by the Heritage Foundation. The conservative policy think tank said DeMint’s bill could reduce the number of uninsured by 22.4 million people in five years. It also provides grants to help people with pre-existing conditions gain access to affordable insurance, and allows Americans to purchase health savings accounts to pay for insurance. ---------------------------------

"The result of Obamacare so far is that we are seeing one new enrollee for every 50 who are losing their plan!"http://www.breitbart.com/Big-Government/2013/11/13/ObamaCare-cancellation-to-enrollee-ration-50-to-1ObamaCare Cancellation to Enrollee Ratio: 50 to 1Though the number is estimated to eventually hit as high as 10 to 15 million, right now the number of insurance policies canceled due to ObamaCare is 5 million. Wednesday, the Obama administration claimed that 106,185 Americans enrolled in ObamaCare. Except, according to the White House, those are not actual enrollments. Some have not paid for but have only only "selected a marketplace plan." Orwellian nonsense aside, that is still somewhere around a 50-to-1 ratio of cancellations to enrollees.

"Democrats are now upside down in 13 states with contested Senate races in less than a year. "2014 is one 6 year senate term (Al Franken, et al) since Barack Obama's Hyde Park speech ("We are the ones we've been waiting for", "the moment when the rise of the oceans began to slow and our planet began to heal") and the exciting Dem sweep of 2008. http://www.electionprojection.com/blog/archives/nov13/2014-senate-elections-preview-110613.phpOf the 14 Republican seats up next year, just one, Susan Collins' seat in Maine, will be held in a state won by President Obama. The other 13 are in states Mitt Romney won by at least 5 points, and nine of those are in states he won by 15 points or more.

http://www.nationaljournal.com/politics/democrats-fear-obamacare-will-cost-them-the-senate-20131126Landrieu's approval rating is now underwater; she tallied only 41 percent of the vote against her GOP opposition. In Arkansas, where advertising on the health care law began early, Sen. Mark Pryor's approval sank to 33 percent, a drop of 18 points since last year. A new Quinnipiac survey showed Sen. Mark Udall of Colorado, who looked like a lock for reelection last month, in a dead heat against little-known GOP opponents. Even a Democratic automated poll from Public Policy Polling showed Sen. Kay Hagan of North Carolina running neck-and-neck against Republican opposition, with her job disapproval spiking over the last two months. These are the types of numbers that wave elections are made of.

"The poor already had unlimited free healthcare in America. This (Obamacare) never was about helping the poorest among us."

It seems to me that too many people are unaware that the poorest among us are receiving more than 4400/yr subsidy PER PERSON for free health care. No one fully understands federal social spending programs, but Medicaid mostly addresses the so-called poor, CHIPS is aimed at up to 200% of the poverty line. Obamacare gives subsidies up to about 400% of the poverty line. And then, of course, we don't count money like this when we measure their income. Please read this in its entirety.

1.46 million of the first 1.6 million to sign up for 'Obamacare' are really enrolling in Medicaid (Is it hard to 'sell' free health care?)

December 7, 2013 | 9:15pmModal TriggerObamaCare created a Medicaid time bomb

The good news, if you want to call it that, is that roughly 1.6 million Americans have enrolled in ObamaCare so far.

The not-so-good news is that 1.46 million of them actually signed up for Medicaid. If that trend continues, it could bankrupt both federal and state governments.

Medicaid is already America’s third-largest government program, trailing only Social Security and Medicare, as a proportion of the federal budget. Almost 8 cents out of every dollar that the federal government spends goes to Medicaid. That’s more than $265 billion per year.

Indeed, already Social Security, Medicare and Medicaid account for 48% of federal spending. Within the next few years, those three programs will eat up more than half of federal expenditures.

And it’s going to get worse. Congress has shown no ability to reform Social Security or Medicare. With ObamaCare adding to Medicare spending, we are picking up speed on the road to insolvency.

The Congressional Budget Office projects that, in part because of ObamaCare, Medicaid spending will more than double over the next 10 years, topping $554 billion by 2023.

And that is just federal spending.

State governments pay another $160 billion for Medicaid today. For most states, Medicaid is the single-largest cost of government, crowding out education, transportation and everything else.

New York spent more than $15 billion on Medicaid last year, roughly 30% of all state expenditures. The Kaiser Foundation projects that over the next 10 years, New York taxpayers will shell out some $433 billion for the program.

But none of these projections foresaw that so many of ObamaCare’s enrollees would be Medicaid eligible.

To be sure, the health-care law’s designers saw the expansion of Medicaid as an important feature of their plan to expand coverage for the uninsured. Still, they expected most of those enrolling in ObamaCare to qualify for private (albeit subsidized) insurance.

It’s beginning to look like that was just another miscalculation, one that could have very serious consequences for the program’s costs.

Moreover, any projection of Medicaid’s future cost to New York taxpayers assumes that the federal government keeps its promise to pay 100% of the cost for Medicaid’s expansion over the next three years and 90% thereafter. But given the growing burden that Medicare will put on a federal budget already facing high debt levels, how likely is it that changes in the federal share of Medicaid will stay off the table?

In fact, as part if last December’s fiscal-cliff negotiations, the Obama administration briefly considered changing to a “blended” reimbursement rate, somewhere between the current and promised rates. The administration quickly backed away from the offer, but it’s likely to come back in the future. If it does, it would cost New York tens of millions of dollars.

Every bit as bad as the cost is the fact that for all this money, recipients are going to get pretty lousy health care.

Of course, one might say that even bad health care is better than no health care. But, unfortunately, for Medicaid, that’s not true.

Other studies show that, in some cases, Medicaid patients actually wait longer and receive worse care than the uninsured.

While Medicaid costs taxpayers a lot of money, it pays doctors very little. On average, Medicaid only reimburses doctors 72 cents out of each dollar of costs. ObamaCare does attempt to address this by temporarily increasing Medicaid reimbursements for primary-care doctors, but that increase expires at the end of next year.

Because of the low reimbursement, and the red tape that accompanies any government program, many doctors limit the number of Medicaid patients they serve, or even refuse to take Medicaid patients at all. An analysis published in Health Affairs found that only 69% of physicians accept Medicaid patients. A study published in the New England Journal of Medicine found that individuals posing as mothers of children with serious medical conditions were denied an appointment 66% of the time if they said that their child was on Medicaid (or the related CHIP), compared with 11% for private insurance — a ratio of 6 to 1.

Even when doctors do still treat Medicaid patients, they often have a harder time getting appointments and face longer wait times. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured.

That’s one reason why so many Medicaid patients show up at the emergency room for treatment. They can’t find a doctor to treat them otherwise.

This not only increases the strain on already overburdened emergency room doctors, but increases the wait for those who arrive with real emergencies.

As bad as this is now, ObamaCare will make it worse by increasing the number of people on Medicaid without doing anything to increase the number of doctors treating them.

We don’t know yet whether the rush to Medicaid will continue. It may be that the troubles with the ObamaCare website might have skewed the early signups. But if ObamaCare really does lead to a massive expansion of this costly and inefficient program, that’s bad news for taxpayers, providers and patients.

Bundler Bets Against ExchangeThe UNaffordable Care Act is destined to be such a flop that one of Obama's biggest campaign bundlers is betting against the federal exchange. The Washington Free Beacon has more: "A major campaign bundler for President Barack Obama is betting on the failure of one of the top federal contractors responsible for the disastrous rollout of the website for the federal government's insurance marketplace. James Chanos made his fortune by short-selling companies before the value of their stock plummeted, most notably the defunct energy firm Enron. His latest target is CGI Group, which is the parent company of CGI Federal. CGI Federal is the lead contractor responsible for Healthcare.gov, the glitch-plagued website of the federal Obamacare insurance exchange." Chanos raised up to $500,000 for Obama's reelection bid. He'll likely make that number look minuscule with the profit he'll make betting on O'Care's demise.

The right answer from my point of view is to get the government, especially the federal government, out of healthcare, except for basic and essential regulations.

To clarify the question though, I think what we are seeking is the best political compromise that could realistically get us out of this train wreck known as Obamacare in the least sociailistic, totalitarian, big government way possible.

Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea.

"I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life," Powell said, according to the Puget Sound Business Journal, last week at an annual "survivors celebration breakfast" in Seattle for those who, like Powell, have battled prostate cancer. "And I don't see why we can't do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing."

Europe, Canada and Korea all have a "single-payer" system, in which the government pays for the costs of health care.

Some Democrats who strongly advocated for, and failed to get, a single-payer system in the 2010 Affordable Care Act, still believe the current law doesn't go far enough to reform the US health system.

A retired four-star general and former chairman of the Joint Chiefs of Staff, Powell told the audience about a woman named Anne, who as his firewood supplier, faced a healthcare scare of her own. Anne asked Powell to help pay for her healthcare bills, as her insurance didn't cover an MRI she needed as a prerequisite to being treated for a growth in her brain. In addition, Powell's wife Alma recently suffered from three aneurysms and an artery blockage. "After these two events, of Alma and Anne, I've been thinking, why is it like this?" said Powell.

"We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care," Powell. "(Let's show) the rest of the world what our democratic system is all about and how we take care of all of our citizens."

Powell, who has taken heat from Republicans for twice endorsing President Obama's election and reelection bids, said he hopes universal healthcare can one day become a reality in the U.S. "I think universal health care is one of the things we should really be focused on, and I hope that will happen," said Powell. "Whether it's Obamacare, or son of Obamacare, I don't care. As long as we get it done."

The growth of Medicaid under ObamaCare effectively takes over all of state spending for the next few years. Forget improvements in education, state universities, or other programs. All the money is going to go for Medicaid.

Already Medicaid accounts for 15% of all state spending totaling $450 billion a year. But, under ObamaCare, it is exploding.

In the state of Washington, where the enrollment process is the furthest advanced, 90% of the enrollments in the state exchanges has been in Medicaid — 52% among those newly eligible under the expansion contained in the ACA and 38% who were previously eligible but hadn’t enrolled.

While the feds will pay the full costs for those who are newly eligible for three years, 90% for another three years, and who knows how much after, the states will only get their normal federal reimbursement for those who have always been eligible but only now applied. Caught up in the hoopla about getting insurance, they are logging onto their state and federal sites only to be told that they are eligible for Medicaid and always have been. But now they are signing up. And the states will only, on average, be able to look to Uncle Sam for about 60% of the cost.

This dragnet is transforming Medicaid from a large program into an enormous one and, with the states on the hook for almost half of the costs for those already eligible, it is a program that the states themselves must finance.

Preliminary estimates suggest that the state share of the new Medicaid expansion could exceed $5 trillion — about 15% of all state revenues. And this sum will come due all at once in the next fiscal year.

Forget any other program. Forget education. Forget about better schools. Forget better roads or mass transit or policing or mental health or local aid. Medicaid is going to suck up all the oxygen in the room.

Indeed, de facto, Medicaid is becoming the single payer that Obama and the liberals have always dreamed of. It stems from the failure of ObamaCare to truly appeal to the middle income middle class. But Medicaid is the de facto order of the day and its expansion is dooming states to a high tax, low services future.

In semi-sound bite fashion, how do we answer the argument that Powell is making here?------------------Okay, you first!

My view is that we need a clean and simple political compromise that a number of Senate DEMOCRATS in red and swing states can grab onto to save face. Amend the Affordable Care Act to allow affordable plans to qualify. Combine this with other cost savings reforms including an individual tax deduction to match what employers take, selling across state lines, healthcare tort reform and mandatory price disclosures. Then move on to improving affordability by improving economic growth!

------------------Powell: "I don't see why we can't do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing."

Powell, as a four-star general in a military hospital, always had good service. Ya think? How are the rest doing at the VA?

Two countries in the world do not have a private healthcare system operating alongside the public system, Canada and North Korea. In Canada, the private healthcare system is to travel to the US. - leaving North Korea alone in that distinction.

Americans just saw the failure of a bureaucracy-based transformation of healthcare. We weren't ready for the full government takeover in 1993 or in 2009. Post-Obamacare, we really aren't ready now! If you take away the private system altogether and there are 80 million or so dissatisfied in the US, where do they go for healthcare. To a private system in Canada?? There is no such thing.

1) Most of these other countries are going broke even though they have lived under the US defense umbrella2) Due to the tax and regulatory burdens of the nanny state these other countries are not having enough children and their populations are contracting, leading to highly unfavorable and worsening ratios between the working and the consuming3) long lines, assembly line practices, no tech advancements,

Oregon Trail of CashThe state of Oregon was supposed to be a poster state for setting up its own ObamaCare exchange. It is, but not in the way we were led to believe. The state squandered more than $300 million in building its exchange only to sign up a grand total of 44 people so far. According to HHS, that's the fewest people in the nation. Remember, this isn't some stubborn red state hoping to torpedo ObamaCare due to ideological opposition. Oregon is a blue state that enthusiastically embraced ObamaCare, agreeing early on to set up its own exchange. Only California and New York received more federal money to make it happen. But nearly $7 million per enrollee isn't too bad.

Obamacare’s Fatal Flawby Martin Feldstein, Professor of Economics at Harvard University and President Emeritus of the National Bureau of Economic Research, chaired President Ronald Reagan’s Council of Economic Advisers from 1982 to 1984.

The potentially fatal flaw in Obamacare is the very same feature that appeals most to its supporters: the ability of even those with a serious preexisting health condition to buy insurance at the standard premium.

That feature will encourage those who are not ill to become or remain uninsured until they have a potentially costly medical diagnosis. The resulting shift in enrollment away from low-cost healthy patients to those with predictably high costs will raise insurance companies’ cost per insured person, driving up the premiums that they must charge. As premiums rise, even more relatively healthy individuals will be encouraged to forego insurance until illness strikes, causing average costs and premiums to rise further....The “wait-to-insure” option could cause the number of insured individuals to decline rapidly as premiums rise for those who remain insured.

"...a better plan: eliminate the current enormously expensive tax subsidy for employer-financed insurance and use the revenue savings to subsidize everyone to buy comprehensive private insurance policies with income-related copayments. That restructuring of insurance would simultaneously protect individuals, increase labor mobility, and help to control health-care costs."

Very interesting post on the "pharmacists". However today most pharmacists are not in their own business like days past when they were their own professionals in their own practices. They are part of huge chains. Hospitals, physicians and nursing homes and others are all becoming corporatized and bigger and bigger corporate chains.

The bigger the better able to cope with all the red tape.

So what do these cuts mean to Walgreens CVS etc.?

I guess the Obama shots response would be they can make it up on volume. Sure, I am happy to make 50% less because I know I can simply make it up by working 50% harder to see 50% more people per day. I get paid less, work harder, patients get less time with me and we are all one happy bunch.

The plan is to get to single payer and then control our health care through a gigantic managed care program. Rationing through restricting resources, use the cheapest drugs possible and a gigantic academic research complex employed to do studies that will support the restrictions.

The 80s show that managed care will control costs for a while till they start to go up again. But it will not be fun or pleasant except for the stakeholders. The providers and patients will be inconvenienced and hassled up the arse. The way care is measured will show that there is not a huge difference in negative "outcomes" so the politburo will claim victory. The truth is that it all depends on the outcomes being measured. Don't think for a second this will be not be manipulated.

Individuals are no longer important - it is all population based measurements. I did see one article questioning the validity of such measurements.

Like I have posted before results of studies can be statistically manipulated in various ways to make them sound like more important than they are.

The pharmaceutical companies do do the same thing. Everyone plays the numbers games to their advantage. The truth is much harder to discern.

I recall Donald Berwick bitching how an insurance company would not let his daughter have a test he said she needed. Well apparently the insurance company thought she did not. He was saying he did not know the criteria they used to deny the test. We need to go in with our eyes open not closed. As if to say when his beaucracy denies care at least there will be some sort of study to back it up.

Well I can tell you the insurance companies also have studies to back up their denials. They don't just deny care totally out of thin air.

So Berwick didn't like being denied but he has no problem being one who denies others when HE decides it ok.

I didn't learn if his daughter who ultimately got the test actually benefitted from it. I can almost guarantee she didn't. But he didn't mind. He didn't pay for it.

Very true. Liberals are not startled by the failure of this complex public-private fiasco, even though it is their own. Tthey will argue for simplicity and point to the way it 'works' for everyone else.

Republicans should have united by now on a solution and alternative to take away the false claim of Dems that R's want to take us back to the way it was, which was the old Dem plan of only 60% government control and runaway costs.

For the billions we are spending on a million, at most, people in the exchanges, we could give them their own doctors and unlimited taxi rides to free appointments.

the goal in 2014 for Republicans, namely to deal with the middle class hard- to-insure while working on the “affordable” part of the equation for others who have or had insurance (before Obamacare took it away)

SHANNON BREAM: So we have another delay in signing up for Obamacare. Today was the drop dead deadline. It was December 15th. That got changed to today. Then quietly there's what they’re calling a grace period, George. How do you think this is going to go over?

GEORGE WILL: You used the word quietly and that's exactly it. This is a -- Obamacare now is a tapestry of coercions mitigated by random acts of presidential mercy announced in the most bizarre ways. Months ago, when they announced the suspension of the employer mandate, it was an assistant secretary of the Treasury, of whom there are twelve, posted it on the Treasury website.

Then, when they a few days ago suspended the individual mandate for certain preferred people, that was announced in a letter from Secretary Sebelius to six Democratic senators, as though this law of the United States was their private property.

This change today wasn't even announced. It was sort of discovered by the Washington Post and it was made on the pretext that they're gearing up for an expected surge of traffic. Which is kind of interesting because the one person we know who signed up today, the president, doesn't even get his health care from anything associated with Obamacare.

Doug and Ginger Chapman with their son Charlie Galanes, 11. They are looking for new coverage after their plan was canceled.The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income of around $100,000 and more than they have ever paid before.

Even more striking, for the Chapmans, is this fact: If they made just a few thousand dollars less a year — below $94,200 — their costs would be cut in half, because a family like theirs could qualify for federal subsidies. ... Christian Johnsen, a bakery owner who lives with his wife and two children in Big Sky, Mont., and has an income of about $88,000, will probably be eligible for subsidies next year. As a result, the family could buy a midlevel insurance plan for about $697 a month.

But if the bakery does better next year, the family could be asked to pay a lot more. Without any subsidy, the same plan would cost $822.

I have not followed this thread or any others in any detail— it has been a very busy few months. However, here are some things I noticed.

This is a very small sample size of a little less than 20. The vast majority of my new health insurance clients this month could not have purchased health insurance on the individual market last year because of diabetes or other medical problems. Currently about half of my clients are getting subsidies and about half aren’t. Both of those may look different in a few months. The older you are the more impressive the subsidies. Subsides are the best deal for Small Business Owners who are able to write off most of their income. Most people who aren’t working with an agent have no idea what they are buying and will be in for a rude awaking when they find out their out of pocket costs and the size of their network.

One school of thought says, do not interrupt when opponents are making fools of themselves. But silence on a real solution to the current healthcare trainwreck will most certainly leave us with a worse sequel. What is the right way forward? Find it and demand it. WSJ today:

What to Do When ObamaCare Unravels

Health insurance should be individual, portable across jobs, states and providers, and lifelong and renewable.

The unraveling of the Affordable Care Act presents a historic opportunity for change. Its proponents call it "settled law," but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.

This fall's website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and "accountable care organizations" will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.

Yet opponents should not sit back and revel in dysfunction. The Affordable Care Act was enacted in response to genuine problems. Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.

There is an alternative. A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system.

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

We need to permit the Southwest Airlines, LUV -0.16% Wal-Mart, WMT +0.21% Amazon.com AMZN +0.55% and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service.

The Affordable Care Act bets instead that more regulation, price controls, effectiveness panels, and "accountable care" organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked? Did we get smartphones by government pressure on the 1960s AT&T T +0.03% phone monopoly? Did effectiveness panels force United Airlines and American Airlines to cut costs, and push TWA and Pan Am out of business? Did the post office invent FedEx, FDX +0.79% UPS and email? How about public schools or the last 20 or more health-care "cost control" ideas?

Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.

Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses.

People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence. Businesses cannot establish or contribute to portable individual policies, or employees would have to pay taxes. So businesses only offer group plans. Knowing they will abandon individual insurance when they get a job, and without cross-state portability, there is little reason for young people to invest in lifelong, portable health insurance. Mandated coverage, pressure against full risk rating, and a dysfunctional cash market did the rest.

Rather than a mandate for employer-based groups, we should transition to fully individual-based health insurance. Allow national individual insurance offered and sold to anyone, anywhere, without the tangled mess of state mandates and regulations. Allow employers to contribute to individual insurance at least on an even basis with group plans. Current group plans can convert to individual plans, at once or as people leave. Since all members in a group convert, there is no adverse selection of sicker people.

ObamaCare defenders say we must suffer the dysfunction and patch the law, because there is no alternative. They are wrong. On Nov. 2, for example, New York Times NYT +1.40% columnist Nicholas Kristof wrote movingly about his friend who lost employer-based insurance and died of colon cancer. Mr. Kristof concluded, "This is why we need Obamacare." No, this is why we need individual, portable, guaranteed-renewable, inexpensive, catastrophic-coverage insurance.

On Nov. 15, MIT's Jonathan Gruber, an ObamaCare architect, argued on Realclearpolitics that "we currently have a highly discriminatory system where if you're sick, if you've been sick or you're going to get sick, you cannot get health insurance." We do. He concluded that the Affordable Care Act is "the only way to end that discriminatory system." It is not.

On Dec. 3, President Obama himself said that "the only alternative that Obamacare's critics have, is, well, let's just go back to the status quo." Not so.

What about the homeless guy who has a heart attack? Yes, there must be private and government-provided charity care for the very poor. What if people don't get enough checkups? Send them vouchers. To solve these problems we do not need a federal takeover of health care and insurance for you, me, and every American.

No other country has a free health market, you may object. The rest of the world is closer to single payer, and spends less.

Sure. We can have a single government-run airline too. We can ban FedEx and UPS, and have a single-payer post office. We can have government-run telephones and TV. Thirty years ago every other country had all of these, and worthies said that markets couldn't work for travel, package delivery, the "natural monopoly" of telephones and TV. Until we tried it. That the rest of the world spends less just shows how dysfunctional our current system is, not how a free market would work.

While economically straightforward, liberalization is always politically hard. Innovation and cost reduction require new businesses to displace familiar, well-connected incumbents. Protected businesses spawn "good jobs" for protected workers, dues for their unions, easy lives for their managers, political support for their regulators and politicians, and cushy jobs for health-policy wonks. Protection from competition allows private insurance to cross-subsidize Medicare, Medicaid, and emergency rooms.

But it can happen. The first step is, the American public must understand that there is an alternative. Stand up and demand it.

Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business, a senior fellow of the Hoover institution, and an adjunct scholar of the Cato institute.

"""One school of thought says, do not interrupt when opponents are making fools of themselves. But silence on a real solution to the current healthcare trainwreck will most certainly leave us with a worse sequel."""

No doubt about it. Republicans can't just sit around complaining about AHA. Eventually the Democrats will fix it enough to get as many people hooked on it as possible. It will not crash onto itself.

"Obviously, we didn't do a good enough job in terms of how we crafted the law," "I am sorry that they, you know, are finding themselves in this situation, based on assurances they got from me." - President Obama

"His major accomplishment was Obamacare, and the implementation of it now is questionable at best." - 39th President Jimmy Carter